Cancer clusters: Challenges in rural areas. The effectiveness of current policies, methods, resources, and impact on small area analysis

The objectives of this cancer cluster paper was to assess the following: website information, staff capacity, expertise and experience, protocols, training needs, and partnerships in 11 western states with large rural areas; the feasibility and accuracy of ascertaining cancer cases in a small rural community that is limited to either zip code or census tract cancer data by using community resources; and whether the two most common study approaches (morbidity and mortality) used by state public health agencies in investigating small rural areas are methodologically and epidemiologically sound.;The following methods were applied: conduct a web-based inventory of each state's public health agency website to identify available information on state cluster programs to include contact personnel, protocol, and general cancer information; conduct a survey to assess the staff capacity, expertise and experience, protocols, training needs, and partnerships in 11 western states with large rural areas; conduct a pseudo-retrospective cohort study of a preselected cohort (identified by the community) of current and former residents of a small rural city; and conduct a rural area evaluation of cancer incidence by zip code, by city specific mortality data, and by a "new" incidence study method that utilizes community resources to ascertain cancer cases specific to the area of concern.;The web inventory indicated that all 11 western states list contact information and some form of cancer information either through cancer reports or general cancer information.;The assessment found significant gaps in the protocol components needed to appropriately conduct a cancer cluster investigation from beginning to end among the 10 states that responded to the survey. These significant gaps can lead to inappropriate study methodologies and outcomes.;It is feasible and plausible to utilize rural community resources to assist state public health agencies and state cancer registries in ascertaining cancer cases specific to the community of concern. This method is cost effective and consumes less personnel and resources.;The results of Study I and II provide evidence that the common study methods used by most state public health agencies appear to be methodologically and epidemiologically unsound, thereby producing questionable rates in small rural areas.